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[Isoproterenol continuous nebulization for childhood status asthmaticus. I. Efficacy and side effects of high-dose
T Takamasu1, S Yanagawa, K Kurihara
1Department of Allergy, Kanagawa Children's Medical Center.
Insights
High-dose isoproterenol continuous nebulization effectively treats childhood status asthmaticus, significantly reducing clinical scores. However, this treatment carries risks of serious side effects, including cardiac events and gastrointestinal issues.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Pharmacology
Background:
- Childhood status asthmaticus is a severe respiratory emergency requiring effective treatment.
- Continuous nebulization therapy is an option for managing severe asthma exacerbations.
Purpose of the Study:
- To evaluate the efficacy and safety of high-dose isoproterenol continuous nebulization in children with status asthmaticus.
- To assess clinical score changes and adverse events associated with this treatment.
Main Methods:
- Thirty-four hospitalized children with status asthmaticus received continuous nebulization of isoproterenol.
- Treatment involved diluting 0.5% dl-isoproterenol in normal saline and nebulizing for an average of 25.5 hours.
- Wood's clinical score was used to assess asthma severity before and after treatment.
Main Results:
- A significant decrease in Wood's clinical score was observed in 32 out of 34 children (average score reduced from 7.7 to 2.9).
- Heart rate increased initially but normalized over time.
- Elevated serum enzymes (GOT, LDH, CPK) and potassium were noted post-treatment, with CPK-MB exceeding normal ranges in most subjects.
- Adverse events included nausea, vomiting, arrhythmia, myocardial infarction, and heart failure in some patients.
Conclusions:
- High-dose isoproterenol continuous nebulization is effective for childhood status asthmaticus.
- The treatment is associated with potential serious side effects, necessitating careful patient selection and monitoring.
- The indication for this therapy should be limited to cases of respiratory failure or impending respiratory failure.
Abstract:
We investigated the efficacy and the side effects of "high-dose isoproterenol continuous nebulization" for childhood status asthmaticus. Subjects were 34 children who were hospitalized and underwent the nebulization therapy. The 50 ml solution of 0.5% dl-isoproterenol was diluted in 500 ml of normal saline and nebulized through an ultrasound nebulizer. The period of continuous nebulization was 25.5 +/- 16.0 hours. The Wood's clinical score clearly decreased in 32 cases, the average score changing from 7.7 +/- 0.8 to 2.9 +/- 1.3. Heart rate was elevated significantly during the first 3 hours (156 +/- 25/min at the start of the nebulization, 180 +/- 20/min at 1 hour, 171 +/- 23 at 3 hours), and then it decreased gradually to 122 +/- 25/min at the cessation of the nebulization. Serum GOT, LDH, CPK, and potassium were elevated after the nebulization compared with the values before the treatment, though the changes were not statistically significant. CPK-MB fraction after the nebulization was higher than normal range in 12 of 13 subjects. Of 34 subjects, 11 (32%) complained nausea or vomited, 2 showed arrhythmia on ECG (ventricular premature conduction), 1 developed myocardiac infarction, and 1 developed possible heart failure, some of which might be attributable to the pharmacological side effects of isoproterenol nebulization. We conclude that "high-dose isoproterenol continuous nebulization" is an effective method for childhood status asthmaticus, but there is some risk of serious side effects. This method was originally developed as a method indicated for the case of respiratory failure or threatened respiratory failure following status asthmaticus, and we should not extend the indication of this method thoughness.